scholarly journals Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110106
Author(s):  
Jessica Anne Vanderlinden ◽  
Rachel Mary Holden ◽  
Stephen Harold Scott ◽  
John Gordon Boyd
Keyword(s):  
Cerebral Oxygenation ◽  
Capture Rate ◽  
Data Capture ◽  
Dialysis Initiation ◽  
Trial Registration ◽  
Neuropsychological Battery ◽  
Consent Rate ◽  
Dialysis Unit ◽  
Individual Level ◽  
High Data

Background: Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown. Objective: To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters. Design: Prospective observational study. Setting: Single-center tertiary academic teaching hospital in Ontario, Canada. Participants: Six patients initiating HD were enrolled in the study. Methods: Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm. Results: Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis. Limitation: This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters. Conclusions: Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated. Trial Registration: Due to the feasibility nature of this study, no trial registration was performed.

scholarly journals P007: A comparative analysis of qSOFA, SIRS and Early Warning Scores Criteria to identify sepsis in the prehospital setting

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S79-S80 ◽  
Author(s):  
S. AlQahtani ◽  
P. Menzies ◽  
B. Bigham ◽  
M. Welsford
Keyword(s):  
Severe Sepsis ◽  
Screening Tool ◽  
Early Recognition ◽  
Capture Rate ◽  
Data Capture ◽  
Prehospital Setting ◽  
Life Saving ◽  
Data Points ◽  
And Performance ◽  
Definition Of

Introduction: Early recognition of sepsis is key in delivering timely life-saving interventions. The role of paramedics in recognition of these patients is understudied. It is not known if the usual prehospital information gathered is sufficient for severe sepsis recognition. We sought to: 1) evaluate the paramedic medical records (PMRs) of severe sepsis patients to describe epidemiologic characteristics; 2) determine which severe sepsis recognition and prediction scores are routinely captured by paramedics; and 3) determine how these scores perform in the prehospital setting. Methods: We performed a retrospective review of patients ≥18 years who met the definition of severe sepsis in one of two urban Emergency Departments (ED) and had arrived by ambulance over an eighteen-month period. PMRs were evaluated for demographic, physiologic and clinical variables. The information was entered into a database, which auto-filled a tool that determined SIRS criteria, shock index, prehospital critical illness score, NEWS, MEWS, HEWS, MEDS and qSOFA. Descriptive statistics were calculated. Results: We enrolled 298 eligible sepsis patients: male 50.3%, mean age 73 years, and mean prehospital transportation time 30 minutes. Hospital mortality was 37.5%. PMRs captured initial: respiratory rate 88.6%, heart rate 90%, systolic blood pressure 83.2%, oxygen saturation 59%, temperature 18.7%, and Glasgow Coma Scale 89%. Although complete MEWS and HEWS data capture rate was <17%, 98% and 68% patients met the cut-point defining “critically-unwell” (MEWS ≥3) and “trigger score” (HEWS ≥5), respectively. The qSOFA criteria were completely captured in 82% of patients; however, it was positive in only 36%. It performed similarly to SIRS, which was positive in only 34% of patients. The other scores were interim in having complete data captured and performance for sepsis recognition. Conclusion: Patients transported by ambulance with severe sepsis have high mortality. Despite the variable rate of data capture, PMRs include sufficient data points to recognize prehospital severe sepsis. A validated screening tool that can be applied by paramedics is still lacking. qSOFA does not appear to be sensitive enough to be used as a prehospital screening tool for deadly sepsis, however, MEWS or HEWS may be appropriate to evaluate in a large prospective study.

scholarly journals Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L. Paul ◽  
John R. Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Trial Registration ◽  
Control Group ◽  
Intervention Period ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia. Methods A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0–2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5–6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. Results There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52). Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage. Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals Protocol for a prospective, cluster randomized trial to evaluate routine and deferred dialysis initiation (RADDI) in Chinese population

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xinju Zhao ◽  
Pei Wang ◽  
Lining Wang ◽  
Xiaonong Chen ◽  
Wen Huang ◽  
...  
Keyword(s):  
Chinese Population ◽  
Heart Function ◽  
Controlled Trial ◽  
Dialysis Initiation ◽  
Trial Registration ◽  
Optimal Timing ◽  
Asymptomatic Patients ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Cluster Randomized

Abstract Background The timing of when to initiate dialysis for progressive chronic kidney disease (CKD) patients has not been well established. There has been a strong trend for early dialysis initiation for these patients over the past decades. However, the perceived survival advantage of early dialysis has been questioned by a series of recent observational studies. The only randomized controlled trial (RCT) research on this issue found the all-cause mortality, comorbidities, and quality of life showed no difference between early and late dialysis starters. To better understand optimal timing for dialysis initiation, our research will evaluate the efficacy and safety of deferred dialysis initiation in a large Chinese population. Methods The trial adopts a multicenter, cluster randomized, single-blind (outcomes assessor), and endpoint-driven design. Eligible participants are 18–80 years old, in stable CKD stages 4–5 (eGFR > 7 ml/min /1.73 m2), and with good heart function (NYHA grade I or II). Participants will be randomized into a routine or deferred dialysis group. The reference eGFR at initiating dialysis for asymptomatic patients is 7 ml/min /1.73 m2 (routine dialysis group) and 5 ml/min/1.73 m2 or less (deferred dialysis group) in each group. The primary endpoint will be the difference of all-cause mortality and acute nonfatal cerebro-cardiovascular events between the two groups. The secondary outcomes include hospitalization rate and other safety indices. The primary and secondary outcomes will be analyzed by appropriate statistical methods. Discussion This study protocol represents a large, cluster randomized study evaluating deferred and routine dialysis intervention for an advanced CKD population. The reference eGFR to initiate dialysis for both treatment groups is targeted at less than 7 ml/min/1.73m2. With this design, we aim to eliminate lead-time and survivor bias and avoid selection bias and confounding factors. We acknowledge that the study has limitations. Even so, given the low-targeted eGFR values of both arms, this study still has potential economic, health, and scientific implications. This research is unique in that such a low targeted eGFR value has never been studied in a clinical trial. Trial registration The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT02423655). The date of registration was April 22, 2015.

scholarly journals Disclosure of payments by pharmaceutical companies to healthcare professionals in the UK: analysis of the Association of the British Pharmaceutical Industry’s Disclosure UK database, 2015 and 2016 cohorts

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023094 ◽  
Author(s):  
Shai Mulinari ◽  
Piotr Ozieranski
Keyword(s):  
Healthcare Professionals ◽  
Median Number ◽  
Pharmaceutical Companies ◽  
Insufficient Information ◽  
Consent Rate ◽  
Individual Level ◽  
Drug Companies ◽  
The Individual ◽  
The Uk ◽  
Insight Into

ObjectivesTo analyse the section of Disclosure UK that pertains to healthcare professionals (HCPs) in order to provide insight into the database’s structure and content and suggest ways to improve its transparency.Design and participantsCohort study of drug companies and HCPs in the 2015 and 2016 versions of Disclosure UK.ResultsCompanies report transfers of value (ToVs) to named HCPs or, where an HCP declines to consent, in aggregate. Only a limited number of variables describe the recipient HCP and the ToV, precluding refined analyses. In 2015, 107 companies reported 54 910 ToVs worth ₤50 967 728. In 2016, 109 companies reported ToVs but spending decreased by 7.3%. The spending was concentrated: the top 10 spenders reported about 50% of the total value, with consultancy-related payments comprising over 70%, and the rest being costs for events. In 2015, 55.5% (30 478) of ToVs worth ₤24 428 619 (47.9%) were disclosed at the individual HCP level, increasing to 64.5% (32 407) and ₤28 145 091 (59.2%) in 2016. Despite increased individual-level disclosure in 2016, the median number of ToVs reported by each company at the individual level was only 57.7%, with 25% of companies reporting less than 38.6%. We found little agreement (62%–48% in 2015 and 46%–30% in 2016) between HCP consent rates that we calculated based on information in the database and those provided by companies.ConclusionsKey deficiencies in Disclosure UK include: insufficient information on payments and recipients, a relatively low HCP consent rate for individual-level disclosure, differences in consent rates across companies and payment types, and reporting ambiguities or inconsistencies. We employ these findings to develop recommendations for improving transparency, including an easily interpretable consent rate statistic that allows for comparison across years, firms and countries. If deficiencies remain unresolved, the UK should consider introducing legislation requiring mandatory disclosure to allow for adequate tracking of industry payments.

scholarly journals A strengths-based data capture model: mining data-driven and person-centered health assets

JAMIA Open ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 11-14
Author(s):  
Grace Gao ◽  
Madeleine J Kerr ◽  
Ruth A Lindquist ◽  
Chih-Lin Chi ◽  
Michelle A Mathiason ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Health Care Policy ◽  
Population Level ◽  
Data Capture ◽  
Data Driven ◽  
Individual Level ◽  
Centered Care ◽  
The Individual ◽  
Health Assets

Abstract With health care policy directives advancing value-based care, risk assessments and management have permeated health care discourse. The conventional problem-based infrastructure defines what data are employed to build this discourse and how it unfolds. Such a health care model tends to bias data for risk assessment and risk management toward problems and does not capture data about health assets or strengths. The purpose of this article is to explore and illustrate the incorporation of a strengths-based data capture model into risk assessment and management by harnessing data-driven and person-centered health assets using the Omaha System. This strengths-based data capture model encourages and enables use of whole-person data including strengths at the individual level and, in aggregate, at the population level. When aggregated, such data may be used for the development of strengths-based population health metrics that will promote evaluation of data-driven and person-centered care, outcomes, and value.

scholarly journals Technology-enabled assessments to enhance multiple sclerosis clinical care and research

2019 ◽  
Vol 10 (3) ◽  
pp. 222-231
Author(s):  
Gabrielle Macaron ◽  
Brandon P. Moss ◽  
Hong Li ◽  
Laura E. Baldassari ◽  
Stephen M. Rao ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Performance Test ◽  
Clinical Care ◽  
Capture Rate ◽  
Patient Reported Outcome Measures ◽  
Data Capture ◽  
Completion Rates ◽  
Mixed Effect ◽  
Low Contrast ◽  
Patient Reported

BackgroundComprehensive and efficient assessments are necessary for clinical care and research in chronic diseases. Our objective was to assess the implementation of a technology-enabled tool in MS practice.MethodWe analyzed prospectively collected longitudinal data from routine multiple sclerosis (MS) visits between September 2015 and May 2018. The MS Performance Test, comprising patient-reported outcome measures (PROMs) and neuroperformance tests (NPTs) self-administered using a tablet, was integrated into routine care. Descriptive statistics, Spearman correlations, and linear mixed-effect models were used to examine the implementation process and relationship between patient characteristics and completion of assessments.ResultsA total of 8022 follow-up visits from 4199 patients (median age 49.9 [40.2–58.8] years, 32.1% progressive course, and median disease duration 13.6 [5.9–22.3] years) were analyzed. By the end of integration, the tablet version of the Timed 25-Foot Walk was obtained in 89.0% of patients and the 9-Hole Peg Test in 94.8% compared with 74.2% and 64.3%, respectively before implementation. The greatest increase in data capture occurred in processing speed and low-contrast acuity assessments (0% prior vs 78.4% and 36.7%, respectively, following implementation). Four PROMs were administered in 41%–98% of patients compared with a single depression questionnaire with a previous capture rate of 70.6%. Completion rates and time required to complete each NPT improved with subsequent visits. Younger age and lower disability scores were associated with shorter completion time and higher completion rates.ConclusionsIntegration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research.

Improving Discrete Data Capture in Synoptic Reports With Optional Free-Text Modifiers

2018 ◽  
pp. 1-6 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Edwin W. Gould
Keyword(s):  
Capture Rate ◽  
Discrete Data ◽  
Data Capture ◽  
Free Text ◽  
Factors Associated ◽  
Additional Information ◽  
Synoptic Reporting

Purpose Upfront, discrete data capture in synoptic reporting fails when pathologists choose a response not associated with discrete data. We sought to determine the factors associated with this event. Methods The results of all “Other” entries in four common tumor sites in synoptic reports were reviewed. Results “Other” entries occurred in 329 of 13,421 questions (2.5%). In 306 of these 329 questions (93.0%), the pathologist appeared to choose this response because they wished to add additional information to an already existing response that was associated with discrete data capture. As a result, the addition of a free-text modifiers to existing responses would allow pathologist to add this additional information while still selecting a response associated with discrete data capture, significantly improving the total discrete data capture (13,092 of 13,421 questions [97.5%] v 13,398 of 13,421 questions [99.8%]; P < .001). Conclusion The addition of free-text modifiers to structured responses in synoptic reports could significantly improve the discrete data capture rate.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽  
2020 ◽  
pp. 1-5
Author(s):  
Shannon Lange ◽  
Courtney Bagge ◽  
Charlotte Probst ◽  
Jürgen Rehm
Keyword(s):  
United States ◽  
Suicidal Ideation ◽  
Random Effects ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
The United States ◽  
Individual Level ◽  
The Past ◽  
Meta Analyses ◽  
Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

Development and Validation of a German Language Unit-Level Organizational Citizenship Behavior (OCB) Scale

2020 ◽  
Vol 36 (5) ◽  
pp. 852-863 ◽  
Author(s):  
George Gunnesch-Luca ◽  
Klaus Moser
Keyword(s):  
Factor Analysis ◽  
Organizational Citizenship ◽  
Organizational Citizenship Behavior ◽  
Helping Behavior ◽  
Citizenship Behavior ◽  
German Language ◽  
Individual Level ◽  
Unit Level ◽  
Confirmatory Factor ◽  
Development And Validation

Abstract. The current paper presents the development and validation of a unit-level Organizational Citizenship Behavior (OCB) scale based on the Referent-Shift Consensus Model (RSCM). In Study 1, with 124 individuals measured twice, both an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) established and confirmed a five-factor solution (helping behavior, sportsmanship, loyalty, civic virtue, and conscientiousness). Test–retest reliabilities at a 2-month interval were high (between .59 and .79 for the subscales, .83 for the total scale). In Study 2, unit-level OCB was analyzed in a sample of 129 work teams. Both Interrater Reliability (IRR) measures and Interrater Agreement (IRA) values provided support for RSCM requirements. Finally, unit-level OCB was associated with group task interdependence and was more predictable (by job satisfaction and integrity of the supervisor) than individual-level OCB in previous research.

Differential Effects of Competence and Morality on Self-Esteem at the Individual and the Collective Level

2020 ◽  
Vol 51 (3) ◽  
pp. 183-198
Author(s):  
Wiktor Soral ◽  
Mirosław Kofta
Keyword(s):  
Self Esteem ◽  
Differential Effects ◽  
Individual Level ◽  
The Subject ◽  
The Individual

Abstract. The importance of various trait dimensions explaining positive global self-esteem has been the subject of numerous studies. While some have provided support for the importance of agency, others have highlighted the importance of communion. This discrepancy can be explained, if one takes into account that people define and value their self both in individual and in collective terms. Two studies ( N = 367 and N = 263) examined the extent to which competence (an aspect of agency), morality, and sociability (the aspects of communion) promote high self-esteem at the individual and the collective level. In both studies, competence was the strongest predictor of self-esteem at the individual level, whereas morality was the strongest predictor of self-esteem at the collective level.

Sign in / Sign up

Export Citation Format

Share Document